Hodgkin's lymphoma and tumor necrosis factor inhibitors in juvenile idiopathic arthritis.

To the Editor: Tumor necrosis factor (TNF)-blocking agents are widely used currently in treatment of juvenile idiopathic arthritis (JIA)1, but there may be as-yet unknown longterm toxicities. There is controversy regarding the increased risk of lymphoma with anti-TNF agents in adults with rheumatoid arthritis (RA), but according to a recent metaanalysis based on 9 randomized controlled clinical trials, there were higher rates of malignancies in patients treated with TNF inhibitors (0.8%) compared to placebo or active controls (0.2%)2. Additionally, there have been 8 cases reported of hepatosplenic T cell lymphoma occurring in patients with pediatric Crohn’s disease treated with infliximab3,…